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HomeMy WebLinkAbout0015 FRAZIER WAY - Health f 115 Frazier Way A - r�. [Marstons Muss i i I I i LO CAT I N SEWAGE PERMIT NO. VILLAGE _ M I N S T A LLER'S NAME i ADDRESS OWNER F�T b- L 2 - ' Ll GATE PERMIT ISSUED 3 2L-3 DATE COMPLIANCE ISSUED Cl { POP J AYOTTE CONST. INC. DATE 10 n N �e �2 176 Main St. Box 884 �. • SANDWICH, MA 02563 NUMBER m , ' C l y ma �' C1t Phone 888-3176 to ° r'�\ Cl) D d a y In z n W O z -i E wm m TERMS: > Dn h}.3� 0 PLEASE DETACH AND RETURN WITH YOUR REMITTANCE S �, •� '}.5 + `ci*t%'q !'>'.+�.rr :-c;:,S+Ych'�„°QK..=-'"stw;a•r 56.z ';asa",L2. .: ,s¢�'t rss, r:" s .gii+x VIM _ O DIv m o' G BALANCE FORWARD 4 m > 0 orq ro 0 -n D m cn o FL r-I > w CD c m o D N CA 1 'c y a. ., �.-. 0 G1 m f"► 12 m 1�+n m \ Ham'. PAY LAST AMOUNT IN THIS COLUMN AYOTTE CONST. INC. No....... ...... Fmic ............. COMMONWEALTH OF THErs BOARD OFHEALTH. V ��"✓ OF .V.1'j.a ... .. --------------------------------- > ApplirFa#ivat for 33ispaaal Worbi Towitru.rtiutt Prrutit • F Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: / �/' S dyi S ................_..--------•---•--•----•--...--......vvs /.............. ....... -. kr" Loo'etion-Address�!.t -- -- 7 �ra� _�ICz :.. s�'t -Qz.�. Owner J Address ...................•----......°?_ fG�.[...�il�. .......... Installer Address / Type of Building Size Lot....l- rC!✓-,.Sq. feet Dwelling—No. of Bedroom�j_.__._J................................. P ( )Showers Cafeteria ( ) Other—Type of Building �f�G�..lrv�r_�z No. of perrsonsnsion Attic (Garbage Grinder ( ) Q' Other fixtures ................. ,+;jl ------- --------- --- W Design Flow.. ...........u��.S_._..............._gallons per person per day. Total daily flow_____'3.^r1�............_........_gallons. WSeptic Tank Liquid'capacity./9 gallons Length................ Width................ Diameter--._--__--__..__ Depth................ x Disposal Trench—N -------- ----------- Width.................... Total Length............. _.... Total leaching area..._....--....__jj___sq. ft. Seepage Pit No........I....__.... Diameter--------� Depth below inlet.....__._.... Total each' rea..9__� ...sq. ft. z Other Distribution box ( ) Dosing tanlf ( � �' -" Percolation Test Results Performed by-------- ? 74._d.:.. o �'d jJ Date.._ .-._/ .................. Test Pit No. 1....�Z___minutes per inch Depth of Test Pit.................... Depth to ground water........................ (� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ o _______ W -_ J_...Iz.--- _eDescnpt n of So>1 - -_.s._.. _ - ---- --- -------• __ _________________________________________________________________________________. ...._ � W ----------------------"__..--_--____-_____-_____-___-_-----.--___-__-___--__---_-__.___-_--_-_-_-_------_____-___-____--_________----_--_-_-___-__---------_-------------___.__............__.__.._..._. UNature of Repairs or Alterations—Answer when applicable---------------------------•---_---_---....................................................... ----------------------------•--------------•----------------------------------------------------------------------------....--------------------------------------------------------------------•-----•• Agreement: V The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'T`:L p 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of healt Sigd-•-•• --•---.• .............................. ............Da--.............. Date Application Approved By----.----- .... ....I....•-- • .� k ------ �' ....................Date Application Disapproved for the following reasons-------------------------------------------------------------------------------------------------------•--------- -------------------------------•----••------•---------•---•-•-------••-•---••-----•-•-----•--•-----•.•--- Date PermitNo.......................................................... Issued....................................................... Date No......................... Fps..........................._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF l--1EA H 49(el !'J......... .......... .....................OF..... .�' .... Appiiration for Bi4#uoui Workg Tomitratrtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: 1'rl_YS-hoh S f�j �/ /�J / //�, .CIUu �/VD..4.— JT 7 �� _- v Y r r/ -•................................................... _---........ -- - Y _ / Loca�t'on-Address r �/ r t o_• l ....... ...................................................................... !.. __. �__. ...-....._..--. �/} 1 L Owner ` Address .. Installer Address Q Ty pe of Building - Size Lot_____•__----:_'=_ _Sq. feet � Dwelling—No. of Bedrooms.___.._1-3 - ,Attic ( ) Garbage Grinder ( ) pa-, Other—Type of Building �tG(r�t/. U�pNo. of persons.......�................ Showers ( /) — Cafeteria ( ) Q' Other fi r s ---------------------- - -- W Design Flow___________________________________,y_y��allons per person per day. Total daily flow...................el.......................gallons. WSeptic Tank Liquid capacity_ 0._`�gallons Length................ Width---------------- Diameter---------------- Depth................ x Disposal Trench—N9. ---•________________ Width ...... Total Length.......... Total leaching area X ............ -t-.sq. ft. Seepage Pit No.................... Diameter........Q. Depth below inlet----- _____ Total c ea.___.__.__.__l/___sq. ft. Z Other Distribution box ( " ) Dosing tank ( . � d Percolation Test Results Performed by....:_.- V ..t%:_:.. .!__:--. �'._.___. Date________________________________________ aTest Pit No. 1.... --minutes per inch Depth of Test Pit____________________ Depth to ground water_-_____---______--___--. w Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ----------------------- - - - -- - - / a0 2 . SGG� -- Descripti n of So .---•--•--•-- --- -- x W U 46 ------------------------ --------------------------......---------------------------------------•-------•-•-•-----------------•--------•---------------------------•------------,-------•-••--------. VNature of Repairs or Alterations—Answer when applicable-----------------------------------------------------------------------------------__---••---_-__. Agreement: The undersigned agrees"tb install the aforedescribed Individual Sewage Disposal System in accordance with the of provisions TITLE, p TITLE, S of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health' Sign �� }ji�v.,�f ------ �` • -----��,_!._L.1 ..__. I� ate Application Approved By...... _9, _ 4 _... Date Application Disapproved for the following reasons:----•----------------------------------------------------------------------------------------------------------- --•-•----------------------•••---------•--••-•-••-•••-•-••-•-----•--•---••-••-•-------.........•-•-•--•---•----•----••-••-•------•----------...----------------------------------------••......---•••-- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF EALTH � i ..................:�'�........OF................ r, -:.............................................. Trrtifiratr of TootpiiFattrr TIJ IS TO CERTIF ,`That vidual Sewage Disposal System constructed ( or Repaired ( ) by......_// . . _....;�'........ .. ` _ ............. •-... ----- . .._.......... ... _ ;41 l nstaller . -_ ..... at• 12' --•-•-• has been installed in accordance with the provisions of TI 1 - j of The tate Sanitary Code•as descr• a in the application for Disposal Works Construction Permit No.. __ ......�_ .�.__________. dated----._ "!'...�. �............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........................&�� G -----------------------•---- Inspector--•- w-_-----------__-------- THE COMMONWEALTH OF MASSACHUSETTS �((++ BOARD O HEALT IT/ ............OF.. ,� ..� ......................... ­....................... ` FEE........................ N� %pou Works Toni rraiti r Permission Weby.granted----•---- ._��'� ...: ------------•--•----•............................•--•--••---...._........_---_:. to Constry,�( - ` or p ( ) eannvidual Se e Di `os�l S t atNo._ n ----------••. �'•-•- ...=� n - ---------------•------•---.......... Street , *5- 1 as shown on the application for Disposal Works Construction Pe i No. ated....s ................................. ........... ..-- �__-l� l�'1! ------� -------------------•-____ �_ 7(y�_ (/ Board ot{Health , DATE._.... =--------------........".---d--•... J FORM 1255 HOBBS & WARREN, INC., PUBLISHERS ..cam 5 4-G°-2 Z= 53 "� 3 �, ' Z Z o�,.1 o f i ,�. ' �gA E j V pAN+ 4t � �4 O t_ p, ff &.r 0) 2g0 r8�r d t � g3�ti 9�Q 1 G;4b L- 4, po r IS WALTER SMITH, JR. ScAL eel r a.r� ✓ J!O 0�jr:%jv% %%N A,/ %r �s5 g�.o . r N U t s C•.t3sK , �6 sg gG eA© tvFr D(AA4. does Sepfte- Tan v. A 4e a A- 0 A 0 o a A Z . s d0 BoT• PoT ELZV, � DEs INN D�T-A : Svl� so I j1 RCot.ATtDN RA-re.. 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